Data from the 2012 National Youth Tobacco Survey indicated that 10% of high school students and 2.7% of those in middle school reported using e-cigarettes at some point in their lives. Both numbers doubled from survey results a year earlier, the CDC said.

"Current use," defined as use within the past 30 days, was reported by 2.8% of high-schoolers and 1.1% of middle school students -- both also doubled from 2010.

E-cigarettes are electronic devices that deliver a flavored nicotine-laced vapor for inhalation. They are not supposed to be sold to minors or marketed for therapeutic purposes, but otherwise they are much less tightly regulated than cigarettes.

The state's Department of State Health Services said that it had recorded "nearly 2,000 pertussis cases so far this year, and the annual total likely will surpass the recent high of 3,358 cases in 2009."

The department issued an alert to the state's physicians and urged all pregnant women to seek vaccination during each pregnancy, as well as fathers, siblings, and anyone else likely to be around newborn infants. Two infants in Texas too young to be vaccinated have died of pertussis this year, officials said.

They found that 28.8% of Medicare patients dying with cancer in 2010 were treated in an ICU during their final month, compared with an average of 23.7% from 2003 to 2007.

Hospice was involved in treatment of 61.3% of terminal cancer patients in the last month of life in 2010, up from 54.6% in 2003-2007. But more than one-sixth of those patients initiated hospice care within 3 days before death.

The Dartmouth Atlas team also found wide variations in end-of-life treatment practices among centers and different parts of the country.

"The care that elderly patients with cancer receive does not always reflect their own preferences, but the prevailing styles of treatment in the regions and healthcare systems where they happen to receive cancer treatment," they wrote.

Whole-Virus HIV Vaccine Promising in Early Trial

Results of a phase I study of a "genetically modified, killed whole virus" vaccine against HIV showed strong immunogenicity and no safety signals, investigators said.

According to a statement issued by Western University in London, Ontario, where Chil-Yong Kang, MD, led the trial, antibodies against the p24 capsid protein increased "as much as 64-fold" in HIV-positive but otherwise healthy individuals.

Antibodies against the gp120 surface antigen rose up to eight-fold, the statement said. "The increased antibody titers were maintained during the 52-week study period," it added, with no serious adverse events reported.

The study randomized 24 HIV-positive participants to receive the SAV001-H vaccine, under commercial development by Sumagen Canada, or placebo. The company said it was inviting other pharmaceutical companies, nonprofits, and governments to help support larger trials.

"At the current time, the 5 tuberculin units/0.1 mL, 5 mL (50 tests), multiple dose vials are unavailable. The 5 tuberculin units/0.1 mL, 1 mL (10 tests), multiple dose vials are in limited supply," the agency said last week. It said the shortage is likely to last "until at least the middle of October."

The only replacement product, JHP Pharmaceuticals' Aplisol, is also subject to a shortage, at least partly because of the increased demand. "Regional shortages have been reported" and customers with an established buying history are receiving preference for existing supplies, the CDC said.

While these shortages persist, the CDC recommended that TB tests be conducted with interferon-gamma release assays instead of tuberculin skin tests where possible. Where the latter are the only feasible option, they should be reserved for "priority usages" such as contact tracing, and Aplisol should be used in place of Tubersol when possible.

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